Healthcare Provider Details

I. General information

NPI: 1134656630
Provider Name (Legal Business Name): WAQAS ULLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FNU WAQAS ULLAH M.D.

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date: 12/18/2017
Reactivation Date: 08/30/2018

III. Provider practice location address

318 CHRIS GAUPP DR
GALLOWAY NJ
08205-4460
US

IV. Provider business mailing address

318 CHRIS GAUPP DR
GALLOWAY NJ
08205-4460
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-9900
  • Fax: 609-404-3653
Mailing address:
  • Phone: 609-404-9900
  • Fax: 609-404-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD473810
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA12620200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT212511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: